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We studied the effects of dexamethasone on proteoglycan (PG) concentration and gene expression in human osteoarthrotic chondrocytes stimulated with IL-1ß. Cartilage samples were taken from 7 patients with osteoarthrosis of the knee and chondrocytes cultivated in alginate beads. Dexamethasone was added in three concentrations (10[sup -5], 10[sup -6], 10[sup -7]M) to IL-1ß (100 pg/ mL)-stimulated chondrocytes. PG concentration was estimated by a dimethylmethylene blue assay. To assess cell proliferation, DNA content was measured fluorometrically. Quantitative Lightcycler-PCR was used to estimate the mRNA levels of stromelysin-1 (MMP-3) and aggrecan (AGG). The proliferation rate was unchanged in all treatment groups. IL-1ß increased MMP-3 expression by 44% and inhibited AGG expression by 16%, but PG-concentration was reduced by 7%. The addition of dexamethasone to IL-1ß-stimulated chondrocytes further reduced the PG concentration by 19% at 10[sup -5]M and by 17% at 10[sup -7]M. The MMP-3 expression was inhibited between 27-53% and the AGG expression between 30-46% by dexamethasone. In osteoarthrotic chondrocytes, dexamethasone in an appropriate dose range reduced the expression of MMP-3 and AGG at the same time. The resulting decrease in PG concentration should be considered when using intraarticular corticosteroids to treat an osteoarthrotic joint. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of hyaluronic acid (HA) on proteoglycan (PG) concentration in alginate cultures of human osteoarthritic chondrocytes and to analyze whether HA exhibit anti-degradative effects in the presence of the cytokine IL-1β.Methods: Cartilage samples from ten patients with osteoarthritis of the knee were harvested and chondrocytes were cultivated in alginate beads. Four groups were cultured: control group with and without IL-1β (500 pg/ml) and HA group (100 μg/ml) with and without IL-1β (500 pg/ml). PG concentration was estimated by a dimethylmethylene blue assay. To assess cell proliferation, we measured DNA content fluorometrically.Results: The proliferation rate (DNA) was unchanged in all culture groups. In the control-group PG/DNA (ng/ng) concentration was 27.1±7.2. Supplementation of the medium with HA decreased PG concentration to 25.3±6.9 (p<0.05). After administration of IL-1β PG/DNA concentration dropped to 23.1±6.0 (p<0.01). By contrast HA treatment of IL-1β stimulated chondrocytes did not further decrease PG concentration (23.9±6.1). In fact the negative effect of isolated HA application was inverted if HA was given with IL-1β (p<0.05).Conclusions: In osteoarthritic chondrocytes cultured phenotypically stable, HA could exhibit protective effects only in the presence of the degradative cytokine IL-1β. Thus, the reported anti-inflammatory effects of HA to cartilage matrix seem to be more indirect by blocking degradative effects of cytokines to the matrix. [Copyright &y& Elsevier]

STUDY DESIGN: Retrospective case series. OBJECTIVE: (1) To analyze clinical and radiographical characteristics, treatment, and outcome in patients with sacral osteoblastoma, (2) to evaluate progression-free survival and local recurrence rate, and (3) to identify prognostic factors. SUMMARY OF BACKGROUND DATA: Osteoblastoma is a rare tumor that has been reported to affect the sacrum from 7% to 17%. Symptoms are various and the diagnosis is often delayed. METHODS: From 1980 to 2010, 18 patients with sacral osteoblastoma (16 males and 2 females) were treated at Rizzoli Institute. Lesion involved S1 (2 cases), S1-S2 (3 cases), S2 (1 case), S2-S3 (1 case), S2-S4 (1 case), S3 (2 cases), S3-S4 (5 cases), S4 (1 case), and almost the entire sacrum in 2 cases. According to Enneking classification for benign bone tumors, 13 (72%) were diagnosed at stage 2 and 5 (28%) at stage 3. Mean tumor volume was 64 cm (range, 2-441 cm). Nine patients had preoperative magnetic resonance imaging. Five patients had a previous inadequate intralesional surgery elsewhere. Treatment consisted in intralesional surgery (16 cases), intralesional surgery and radiotherapy (1 case), and wide resection (1 case). Local adjuvants used were phenol (7 patients), cryocoagulation with 'iceball' technique (1 case). Embolizations were performed in 7 patients. RESULTS: At a mean of 8.4 years (range, 1-28 yr), 15 patients (83%) remained continuously disease free, whereas 3 patients had local recurrence (17%). Progression-free survival was 87% at 5 years and 74% at 10 years. No statistical difference was found between patients who received or not local adjuvants (P = 1.254), older or younger than 20 years (P = 0.970), at stage 2 or 3 (P = 0.826), evaluated preoperatively with or without magnetic resonance imaging (P = 0.160), primarily treated versus patients with previous intralesional surgery elsewhere (P = 0.131). CONCLUSION: In our series, curettage was successful in most of the patients. Local adjuvants did not seem to reduce the risk of local recurrence when combined with intralesional surgery.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study of 55 consecutive patients with spinal metastases secondary to breast cancer who underwent surgery., Objective: To evaluate the predictive value of the Tokuhashi score for life expectancy in patients with breast cancer with spinal metastases., Summary of Background Data: The score, composed of 6 parameters each rated from 0 to 2, has been proposed by Tokuhashi and colleagues for the prognostic assessment of patients with spinal metastases., Methods: A total of 55 patients surgically treated for vertebral metastases secondary to breast cancer were studied. The score was calculated for each patient and, according to Tokuhashi, the patients were divided into 3 groups with different life expectancy according to their total number of scoring points. In a second step, the grouping for prognosis was modified to get a better correlation of the predicted and definitive survival., Results: Applying the Tokuhashi score for the estimation of life expectancy of patients with breast cancer with vertebral metastases provided very reliable results. However, the original analysis by Tokuhashi showed a limited correlation between predicted and real survival for each prognostic group. Therefore, our patients were divided into modified prognostic groups regarding their total number of scoring points, leading to a higher significance of the predicted prognosis in each group (P < 0.0001), and a better correlation of the predicted and real survival., Conclusion: The modified Tokuhashi score assists in decision making based on reliable estimators of life expectancy in patients with spinal metastases secondary to breast cancer.

We retrospectively evaluated the results after corporectomy and vertebral body replacement in 40 patients with thoracic or lumbar spine collapse due to tumour osteolysis, unstable fractures, spondylodiscitis and Paget's disease. They underwent posterior transpedicular instrumentation followed 7 to 21 days later by vertebral body replacement with a distractible device, the "Obelisc" cage, filled up with autogenous/allogeneic bone graft. The mean residual kyphosis after surgery was only 13.8 degrees. After a mean follow-up period of 16.3 months, there was a mean loss of correction of 1.1 degrees. Perioperative complications occurred in 25 patients (62.5%); one died of septic shock, and the others were treated conservatively. Postoperatively, neurological improvement was noted in 8 patients. Using this in situ distractible vertebral body replacement system to achieve intraoperative stabilisation, neurological improvement and minimal postoperative displacement were achieved with an acceptable perioperative risk.

Oesophageal cancer is frequently complicated by malignant fistulae. Necrosis of the tumour following radiotherapy or chemotherapy may lead to the development of fistulae between the oesophagus and adjacent tissues and organs. We report the expansion of an extra-luminal oesophageal cancer after resection, invading the cervico-thoracic spine, fortunately without neurological deficit, and leading to instability and formation of a malignant fistula linking the tracheo-bronchial tree to the subarachnoidal space. To prevent imminent paraplegia and to alleviate severe pain, we rigidly stabilised the spine at the cervico-thoracic junction using an angle-stable system through a single posterior approach. Further postoperative follow-up revealed no signs of neurological deterioration. Cervico-thoracic stability was preserved until the patient died nearly five months postoperatively. This case shows that posterior stabilisation and decompression may be a palliative option for patients with imminent paraplegia and severe pain due to advanced tumour infiltration of the cervico-thoracic spine.

After multiple revisions of her right hip arthroplasty, an 83-year-old woman developed deep infection with a chronic draining sinus. In August 2002 severe acute bleeding occurred through this fistula. Angiography revealed a pseudoaneurysm of the right external iliac artery. Because of the multiple pathologies affecting this ASA grade IV patient, conventional surgical treatment was considered to be contra-indicated, and a stent was placed percutaneously under fluoroscopic control to seal the vascular laceration. No haematoma and no further bleeding was observed on the control CT-scan or at angiography. However the patient died with terminal renal failure forty days later. The case reported shows a rare complication of total hip arthroplasty. The method used in this case to seal the leakage, using a covered stent, is uncommon but effective in cases where conventional surgery is contra-indicated.